News-At-A-Glance: Beneficiary Inducements

Health care providers can induce beneficiaries to use their services in much the same way that they can induce physicians and other referring parties as evidenced by a recent settlement by a major drug store. Rite Aid Corp. in early December settled with the government for $2.99 million in a case where the chain allegedly used gift cards as a means to induce patients to use their pharmacies instead of others. Using gift cards and other forms of influencing patient decisions to use one provider over another is not new. The Health and Human Services Office of Inspector General issued a special bulletin in August 2002 advising providers not to give cash or cash equivalents, including gift cards. Laboratories should pay attention to this case, which is based on a whistleblower lawsuit, because as patients are allowed more direct access to laboratory services, the issue of beneficiary inducements could become an additional compliance risk for laboratories. In the case of a laboratory, while tests for Medicare and Medicaid patients would not qualify for reimbursement because those programs require a physician to order tests, there may be state-based anti-kickback laws that would be implicated by this scenario.